LAUSANNE — She's seen me naked. How can I leave her? He brought me so much. How can I tell him I'm leaving? I spent so much time finding the right one. Now we're supposed to just split up? And yet things were clear from the start: This was always going to be a temporary relationship. It had to be faced. I had to leave my shrink.
But there's an art and a way of doing this. Some people do it in stages. Others goof up their leave-taking. "It's an extraordinarily complex question," says Ignacio Pelegri, a psychoanalyst in Geneva. "It's as if I were to ask you how to put an end to your relationship with your parents. Does that relationship ever really end? In one way, yes. Parents do at some point distance themselves from their parental roles. But the connection is lost beyond a certain framework."
In most cases, the relationship with a shrink ends by common agreement. "The end of analysis is the end of a creative process," says Jean-Marc Chauvin, also a psychoanalyst in Geneva. "At some point in the analytical trajectory both the analysed and analyst get the feeling some process has reached an end, even if there are still some open questions," he says. "For example, tomorrow I intend to end a relationship of four years with one of my patients. He and I agree there remain some things to see to. I even have the intuition that he's stopping at a time when he would be ready to deal with some painful and threatening things. But together we have understood and tied up things that will now help him make his way on his own."
Dag Söderström, a psychiatrist, psychotherapist and Lausanne-based member of the Swiss Medical Assciation (FMH) describes therapeutic work as "a spiral path." He says that even as patients progress, they keep returning to the same questions. "But as we do so our point of view gets richer," he says. "A good time to stop is when you get the impression a circle has closed."
A question of timing
The eventuality of the separation is discussed several months ahead. It needs to have time to mature, to be evaluated by both parties until it's acceptable to both. That's a process that can sometimes play out over years. "For some people, the place where the therapy took place is the place where they built a new personality," says Söderström. "So it's difficult for them to envisage leaving this seminal place."
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Going bananas? — Photo: James Nash
On average, an analysis lasts between five and 10 years, and therapy two to five years. So why not set a date for the end of therapy right from the outset? "The unconscious needs to know it has time to express itself," says Jean-Marc Chauvin. "All limits encourage the subjet to hold back. It's as if you were to meet somebody and you know that person's going to leave the country in a few months. You won't invest in that relationship in the same way you would if their presence wasn't just going to be for a limited amount of time."
Some therapist/patient couples end up never leaving each other. "When the therapy ends, the relationship doesn't and it can be reactivated," says Söderström. "Some patients return when they are confronted with new existential problems. Because it's easier to work with a known therapist. It's a simple question of efficacy." But doesn't that indicate a form of dependence? "In general, the issue of dependence in relationships is one that has existed well before the therapist arrives on the scene," he says. "Therapy makes it possible to become aware of it, to live the dependence in a safe framework, to name it and work on it. In and of itself dependence is not an illness."
Cut and run?
At the other end of the spectrum are patients who leap from a moving train and leave the therapeutic relationship from one day to the next, without letting the therapist know. "That can be linked to a need to put some distance between the one who was dropped and the framework of the analysis," says Ignacio Pelegri. "They are replaying things that happened in the relationship with the psychoanalyst, things that the person experienced. If it was traumatic, the patient could be feeling the sudden need to take distance."
In such cases it is rare for an analyst or therapist to hold on to their patient or try and make them come back. "On the other hand, if the analyst or therapist senses that the need for distance is a kind of escape, they could share that with the patient who could then feel relief at having been understood," says Pelegri.
Then there are the cases where the shrink him or herself, with goodwill, pushes the patient towards the exit door. "Doctors and psychiatrists — all those who protect patients from death — are invested with something eternal," says Söderström.
"The patient sometimes imagines that the disappearance of the shrink will lead to the disintegration of everything they've built within the framework of the therapy," he adds. "When such anxieties manifest, they generally prompt me to tell the patient it’s time to stop. Just to prove to the patient that it’s not true, that they’ve now got all they need to deal with things themselves. But I always leave an open door. And I invite them to keep in touch, to write to me to let me know how things are going.”